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Review Article 


Hassan Nasser Alrashed et al, 2019;3(7):625–627.

International Journal of Medicine in Developing Countries.

Laparoscopic gastrostomy in gastric surgeries: a systematic review

Hassan Nasser Alrashed1*, Mahmoud Abdullah Alabbad1, Hussain Abdrabalrasool Alturaifi1, Hussain Jawad Albuali1, Qasem Mohammed Alhababi1, Murtadha Hussain Alrashed1

Correspondence to: Hassan Nasser Alrashed

*Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.

Email: nhassanrs [at] hotmail.com

Full list of author information is available at the end of the article.

Received: 16 January 2019 | Accepted: 30 January 2019


ABSTRACT

Laparoscopic surgery originated from the diagnostic laparoscopy which underwent several modifications and advancements in recent years. This surgery has become a gold standard for many organ systems based surgeries; the widely employed laparoscopic gastrostomy (LG) is the best example for it. The management of gastric cancer has always remained a challenge. The aim of the current study was to investigate the application of LG in gastric surgeries. Scientific online databases were used to search for articles related to the current subject, the inclusion criteria of article were recently published and included gastric or abdominal applications. Among the 24 articles obtained, only five articles were selected which were published between the years 2015 and 2018. The articles were summarized systematically according to well-defined criterions. LG was found effective in major abdominal emergencies and gastric cancer treatment. LG was also found to be superior and advanced than other available techniques.


Keywords:

LG, gastric cancer, gastric surgery.


Introduction

Diagnostic laparoscopy has been improved to laparoscopic surgery by Semm and Muehe at the binging of the 1980s [1]. This surgery became the gold standard for many organ systems such as the digestive system [2]. Gastric cancer is one of the most lethal cancer types causing death, it acts as the fourth most common malignancy globally. In 2008, there were 1 million new stomach cancer cases estimated [3]. The management of gastric cancer is a challenge due to the high mortality to incidence ratio [4]. The modern strategy of gastric cancer treatment started in the late 18th century. In 1881, the first successful subtotal gastrectomy has been performed after the first total gastrectomy which was performed in 1879 [5]. Later in the 20th century, open gastrectomy, either subtotal or total, became the fundamental therapy for gastric cancer in patients with non-metastatic disease. Minimally invasive surgery for gastric cancer which has been performed in 1992 using the first laparoscopic-assisted gastrectomy gastric cancer is of two types, total and distal gastrectomy [6]. Laparoscopic distal gastrectomy (LDG) is the most minimally invasive curative procedure; it is performed for gastric cancer in an early stage. Laparoscopic total gastrectomy (LTG) involves substantial difficulties in the surgical approach, so advanced technical skills are required for safe LTG [7]. Long term effectiveness of laparoscopic gastrostomy (LG) is still remaining to be studied considering greater procedural complexity, intra-abdominal hyper pressure, lower lymph node harvest, pneumoperitoneum carbon dioxide, and longer operation period [8,9]. The aim of the current systemic review was to investigate the application of laparoscopic in the gastrointestinal field, especially for gastric cancer.


Data Collection

This systemic review was performed on the laparoscopic application of gastric surgery, especially for gastric cancer. We searched for related articles by using online databases including PubMed, Google, and Research Gate using several keywords including “laparoscopic, application of laparoscopic, laparoscopic in gastric surgery, laparoscopic in gastric cancer.” We obtained 28 articles; by reviewing the titles, we excluded 23 articles as they were either meta-analysis, review articles, systematic reviews, or articles published before 2015. At last, five articles selected which were published between the years 2015 and 2018 and written in the English language.


Results

We summarized articles that were selected after reviewing the abstract and the full articles using specific points as based on author and publication year, study design, number of patients and age, the aim of the study, techniques used, diseases to be treated, results, and main findings. The studies included in the current systematic review were recently published, there was one article published in 2018 [10], one in 2017 [11], one in 2016 [12], and two in 2015 [13,14]. There was one prospective study [13] and four retrospective studies [10,11,12,15]. The total numbers of patients in the five included articles were 2,368. There were four articles [10,1214] targeting gastric cancer patients, while only one study [11] was conducted on patients with major abdominal emergency surgery. Regarding the technique used, two studies used robotic gastrostomy (RG) and LG to compare the short- and long-term outcomes between the two techniques in D2 lymph node dissection in advanced cancer patients [10]. The other study used robotic distal subtotal gastrostomy with D2 lymphadenectomy (RDGD2) and laparoscopic distal subtotal gastrectomy with D2 lymphadenectomy (LDGD2) to compare the quality of each technique in gastric cancer patients with different body mass index (BMI) [14]. One study [12] used reduced port laparoscopic distal gastrostomy (RPLG) and reduced port laparoscopic total gastrostomy (RPLTD) in gastric cancer patients to evaluate the surgical advantages of RPLG. Another study used laparoscopic and open gastrectomy to compare between the two techniques in patients with gastric cancer [13]. The last study used an initial laparoscopic approach and laparotomy to assess the safety and effectiveness of each technique in a major abdominal emergency [11]. Regarding major abdominal emergency, it was concluded that the initial laparoscopic approach was better [11]. By comparing laparoscopic with open gastrostomy in resectable gastric cancer, laparoscopic gastrectomy was hypothesized to result in similar mortality rates and oncologic outcomes to open gastrectomy [13]. Regarding advanced cancer, it was found that RG was over LG regarding D2 lymph node dissection as it was feasible and safe [10], also robotic surgery (RDGD2) showed the effectiveness and it was higher than that of LDGD2 in treating gastric cancer in patients with high BMI [14]. By comparing two different techniques of laparoscopic surgeries, RPLG and RPLTD, it was found that both of techniques did not differ in the blood loss or morbidities, resulting in satisfactory procedure and high survival rate for gastric cancer patients, but they should be performed by an experienced laparoscopic gastric surgeon who has sufficient experience [12].


Discussion

The current systematic review was performed to investigate the application of LG in gastric surgery, especially in gastric cancer surgery. We found five articles focused on this subject, one was conducted on laparoscopy in major abdominal emergencies and the four articles were conducted on the laparoscopic application in gastric cancer. Laparoscopy showed its safety and effectiveness in major abdominal emergencies, where patients who performed it had shorter hospital stay after the operation and a lower rate of complications [11]. The study that compared laparoscopy with open gastrostomy in gastric cancer was a prospective randomized controlled trial and the authors hypothesized that LG would result in better outcomes than open gastrostomies, such as shorter hospital stay after the operation, lower postoperative morbidity, higher cost effectiveness, better postoperative quality of life, and less readmission [13]. Other studies [10,12,14] compared other types of LG with each other and other advanced techniques. RG [10] and robotic subtotal gastrectomy with D2 lymphadenectomy [14] were over laparoscopic gastrectomy and RDGD2, respectively. The former technique was better than LG as it was feasible and safe for removal of lymph node D2 in case of advanced gastric cancer [10]. The later (robotic subtotal gastrectomy with D2 lymphadenectomy) showed less blood loss and effectiveness in gastric cancer patients with higher BMI than laparoscopic approach [14]. Both of RPLG and RPLTD showed no significances regarding blood loss and postoperative morbidities; however, they need an experienced surgeon to perform this operation [12]. There were several meta-analyses and systematic review conducted to assess applications of different types of laparoscopic in gastric cancer. One systematic review and meta-analysis [15] revealed that no evidence were found to confirm that LG was inferior to open gastrostomy in advanced gastric cancer. In our systematic review, only one prospective trial hypothesized that LG was better than open gastrostomy [13]; however, the study was a prospective trial, so further studies (retrospective studies that involve long follow-up period) need to be conducted. Another systematic review and meta-analysis [16] reported similar results to ours that RG was safe, but it required a long time and more efforts, especially from the surgeon’s side.


Conclusion

LG was effective in major abdominal emergencies, but in the case of gastric cancer, it may be superior to other more advanced techniques, also the advanced techniques of this application require a skillful experienced surgeon.


List of Abbreviations

LDGLaparoscopic distal gastrectomy
LDGD2Laparoscopic distal subtotal gastrectomy with D2 lymphadenectomy
LGLaparoscopic gastrostomy
LTGLaparoscopic total gastrectomy
RDGD2Robotic distal subtotal gastrostomy with D2 lymphadenectomy
RGRobotic gastrostomy
RPLGReduced port laparoscopic distal gastrostomy
RPLTDReduced port laparoscopic total gastrostomy

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Not applicable.


Ethical approval

Not applicable.


Author details

Hassan Nasser Alrashed1, Mahmoud Abdullah Alabbad1, Hussain Abdrabalrasool Alturaifi1, Hussain Jawad Albuali1, Qasem Mohammed Alhababi1, Murtadha Hussain Alrashed1

  1. Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia

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How to Cite this Article
Pubmed Style

Alrashed HN, Alabbad MA, Alturaifi HA, Albuali HJ, Alhababi QM, Alrashed MH. Laparoscopic gastrostomy in gastric surgeries: a systematic review. IJMDC. 2019; 3(7): 625-627. doi:10.24911/IJMDC.51-1547641509


Web Style

Alrashed HN, Alabbad MA, Alturaifi HA, Albuali HJ, Alhababi QM, Alrashed MH. Laparoscopic gastrostomy in gastric surgeries: a systematic review. http://www.ijmdc.com/?mno=26528 [Access: May 27, 2019]. doi:10.24911/IJMDC.51-1547641509


AMA (American Medical Association) Style

Alrashed HN, Alabbad MA, Alturaifi HA, Albuali HJ, Alhababi QM, Alrashed MH. Laparoscopic gastrostomy in gastric surgeries: a systematic review. IJMDC. 2019; 3(7): 625-627. doi:10.24911/IJMDC.51-1547641509



Vancouver/ICMJE Style

Alrashed HN, Alabbad MA, Alturaifi HA, Albuali HJ, Alhababi QM, Alrashed MH. Laparoscopic gastrostomy in gastric surgeries: a systematic review. IJMDC. (2019), [cited May 27, 2019]; 3(7): 625-627. doi:10.24911/IJMDC.51-1547641509



Harvard Style

Alrashed, H. N., Alabbad, . M. A., Alturaifi, . H. A., Albuali, . H. J., Alhababi, . Q. M. & Alrashed, . M. H. (2019) Laparoscopic gastrostomy in gastric surgeries: a systematic review. IJMDC, 3 (7), 625-627. doi:10.24911/IJMDC.51-1547641509



Turabian Style

Alrashed, Hassan Nasser, Mahmoud Abdullah Alabbad, Hussain Abdrabalrasool Alturaifi, Hussain Jawad Albuali, Qasem Mohammed Alhababi, and Murtadha Hussain Alrashed. 2019. Laparoscopic gastrostomy in gastric surgeries: a systematic review. International Journal of Medicine in Developing Countries, 3 (7), 625-627. doi:10.24911/IJMDC.51-1547641509



Chicago Style

Alrashed, Hassan Nasser, Mahmoud Abdullah Alabbad, Hussain Abdrabalrasool Alturaifi, Hussain Jawad Albuali, Qasem Mohammed Alhababi, and Murtadha Hussain Alrashed. "Laparoscopic gastrostomy in gastric surgeries: a systematic review." International Journal of Medicine in Developing Countries 3 (2019), 625-627. doi:10.24911/IJMDC.51-1547641509



MLA (The Modern Language Association) Style

Alrashed, Hassan Nasser, Mahmoud Abdullah Alabbad, Hussain Abdrabalrasool Alturaifi, Hussain Jawad Albuali, Qasem Mohammed Alhababi, and Murtadha Hussain Alrashed. "Laparoscopic gastrostomy in gastric surgeries: a systematic review." International Journal of Medicine in Developing Countries 3.7 (2019), 625-627. Print. doi:10.24911/IJMDC.51-1547641509



APA (American Psychological Association) Style

Alrashed, H. N., Alabbad, . M. A., Alturaifi, . H. A., Albuali, . H. J., Alhababi, . Q. M. & Alrashed, . M. H. (2019) Laparoscopic gastrostomy in gastric surgeries: a systematic review. International Journal of Medicine in Developing Countries, 3 (7), 625-627. doi:10.24911/IJMDC.51-1547641509